Acupuncture Helps Reduce Need for Sedative Medications in Neonates and Infants Undergoing Treatment in the Intensive Care Unit: A Prospective Case Series

Abstract

Background: Neonates in intensive care frequently require impressively high doses of opioids and benzodiazepines to manage pain and provide sedation, and discontinuation of these agents often leads to symptoms of withdrawal and increased agitation. Acupuncture, known to attenuate symptoms of pain and withdrawal in adults, may be useful for managing withdrawal symptoms, pain, and agitation in neonates and infants.Objective: This prospective case series of 10 patients was designed as a preliminary pilot study to examine if acupuncture was beneficial and led to reduction of symptoms of withdrawal and agitation in neonates and infants.Methods: The patients with demonstrated symptoms of agitation and withdrawal were treated with an acupuncture protocol consisting of National Acupuncture Detoxification Association acupuncture points and body points (Yin Tang, ST 36, and PC 6.) Results: The patients tolerated acupuncture well and required a decreased amount of prn medication for treating agitation and withdrawal. Conclusions: Acupuncture may be a useful adjunct for managing agitation and withdrawal in neonates and infants in the intensive care unit, and may lead to a decreased need for sedative medications. Further studies, in the form of randomized, blinded controlled trials, are needed to explore acupuncture's efficacy in this setting.

A Review on Acupuncture as a Non-Pharmacological Treatment for Neonatal Abstinence Syndrome (NAS)

“…Two studies were able to detect acupuncture points in neonates with NAS which suggests that newborns can be treated with acupuncture [19,20]. There is some evidence that acupuncture decreases LOS, duration of pharmacological treatment, and the Finnegan score [23,26,27]. These all can translate into a longer time spent with the mother that can be beneficial for the child's neurodevelopment [8].…”

“…A case series (n=10) by Golianu et al examined needle acupuncture and its effects on acute withdrawal symptoms in neonates that were exposed to opioids and benzodiazepines [26]. These infants were not diagnosed with NAS but this study is still important to include since these withdrawal symptoms that they experienced are similar to NAS symptoms.…”

“…Most studies in the current review used the Finnegan score or a modified version of it to assess the need to treat NAS and the efficacy of acupuncture to alleviate NAS symptoms [23,24,27]. However, two studies used other measurements including subjective assessment from nurses or the amount and number of opioid dosages given throughout the study period [25,26]. This makes it difficult to combine these studies to determine acupuncture's efficacy.…”

Multidisciplinary Pain Management for Pediatric Patients with Acute and Chronic Pain: A Foundational Treatment Approach When Prescribing Opioids

“…For the purpose of this review, we focus on four frequently utilized interventions in U.S. pain clinics, which include three psychologically based interventions: cognitive behavioral therapy, mindfulness, and medical hypnosis. Acupuncture, an integrative medicine approach widely used in pain management clinics, is additionally reviewed [39,42,43,44,45]. Rehabilitative therapies, including physical and occupational therapy (PT, OT), are also an important part of the treatment of chronic pain and are regularly integrated into care to support pain management and increase function [39,46,47,48,49].…”

“…In a randomized controlled trial to treat Neonatal Abstinence Syndrome, acupuncture led to a shorter duration of morphine treatment (28 days vs. 39 days in the control group; p = 0.019) and hospital stay (35 vs. 50 days in the control group; p = 0.048) [123]. Another study demonstrated that a course of acupuncture was helpful in supporting infants wean off a high dose opioid infusion in the intensive care unit [43].…”